Vaccines against human papillomavirus (HPV) are FDA-licensed for both males and females ages 9-26 years old and are most effective when given before sexual exposure to the virus. HPV is the most common sexually transmitted infection (STI) in the US and infects approximately 50% of sexually active males and females. HPV causes genital warts and is associated with cervical, vaginal, vulvar, anal, penile, and throat cancers. Minority racial and ethnic populations are disproportionately at higher risk for STIs and HPV-related cancers than are White. The first of two HPV vaccines for females was licensed in 2006 to protect against cervical cancer and genital warts. HPV vaccine for males was licensed in 2009 to protect against genital warts and in 2010 against anal cancer. CDC's Advisory Committee on Immunization Practices recommends routine HPV vaccination for females and a less directive permissive (allowed but not in routine schedule) vaccination for males. This project uses dissemination strategies to stimulate communication about HPV vaccine among parents, healthcare providers and pre-teen boys at a critical time when the vaccine is new to both parents and clinical practice. Dissemination strategies are based on the Health Belief Model and message design theories. The intervention in a 13 county region in North Carolina includes (1) a social marketing campaign for parents with radio announcements, posters and brochures, and (2) collaboration with healthcare providers of pre-teen boys using posters and brochures to stimulate parent awareness of HPV vaccine for males. The overall objective is to assess the extent to which parents and providers respond to dissemination strategies by deciding on HPV vaccine for pre-teen boys. The long term goal is to promote male sexual health through early intervention and prevention of HPV related disease. The central hypothesis is that parents and providers are relevant decision makers who can be motivated to ensure pre-teen boys' future sexual health. The aims are to (1) Evaluate a set of dissemination strategies that promote HPV vaccine in pre-teen boys, especially among racial and ethnic populations at greater risk of disease; (2) Assess whether a theory-based social marketing campaign affects parents' motivations to vaccinate preteen sons against HPV; (3) Assess whether a theory-based social marketing campaign affects providers' motivations to vaccinate preteen male patients against HPV. Pre and post intervention cross-sectional, independent sample telephone surveys, each with 325 parents of 9-13 year old boys, will assess parents' response to the campaign. Pre and post intervention surveys of a sample of 350 healthcare providers will assess practices on HPV vaccine recommendation. NC Immunization Registry data will be analyzed to compare HPV vaccination rates in intervention counties with a control group of 19 similar counties and all 87 non-intervention counties. We anticipate the research will yield effective dissemination strategies that can be broadly used to reduce HPV infection in males, especially racial and ethnic populations. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because it will disseminate gender-based research to reduce racial and ethnic disparities in HPV-related disease through HPV vaccination of males in early adolescence. The project is relevant to NIH's mission because it will have a positive effect on dissemination and implementation of HPV vaccine for males by optimizing communication among parents, healthcare providers and pre-teen boys.